Poverty simulation designed to help staff better understand everyday struggles - VHA SimLEARN
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Poverty simulation designed to help staff better understand everyday struggles

By Laura Conklin, MSN, RN, CHSE
VA Connecticut Healthcare System 

WEST HAVEN, Conn. – Recently, the VA Connecticut Healthcare System hosted its third annual poverty simulation, “A Day in the Boots of a Hero.” This interactive, inter-professional simulation was a collaborative education endeavor between VA Connecticut and Fairfield University with the objective to increase awareness and sensitivity for our Veteran population living in poverty. 

According to the United States Census Bureau (2014), the official poverty rate was 14.8 percent; more than 46 million people are living in poverty. Living in poverty can affect not only access to health care, it can also create barriers to making health care a priority. As Majerol (2017), stated, “Cost can pose a barrier to factors that allow people to live a healthy lifestyle such as accessing health care and healthy food. Moreover, people with low socioeconomic status are more likely to live in areas with higher concentrations of air pollution. Poverty can cause cumulative disadvantages that can negatively impact health.”

During the poverty simulation, participants were assigned a role within an impoverished family and had to navigate through the system. They were given obstacles such as bills to pay, getting to work and/or looking for work, and possible childcare issues. Each 15-minute block of time represented a week of the family. Together the families had to trouble shoot and navigate the system and interact with various real-life social service agencies. A debriefing followed each “week” and participants shared the challenges and frustrations they encountered. 

The simulation event was comprised of several disciplines; each of which could share experiences of how they have seen examples in the work or personal setting. Participants included nurses, nursing students, physicians, pharmacists, social workers, psychologists, police officers and a chaplain. 

Feedback was positive and demonstrated an increased sensitivity to the challenges that Veterans may face when living in low income households. Examples of the feedback included:

“In my present position, I handle Veterans with their re-imbursement of funding for which they are entitled. This learning activity definitely helped me become more sensitive to our Veterans’ needs. I notice I am not just looking at the Veteran in front of me; but I am considering the bigger picture when dealing with our Veterans and their situations. My hope is that our Veterans can notice this change in me and that I am a more caring individual.” 

“Understanding that a family who is not able to satisfy their basic needs such as security, shelter, food, clothing, etc. (Maslow’s Hierarchy of needs) may not be able to get their health issues addressed until it is imminent.”

VA Connecticut and Fairfield University will continue to offer this simulation training annually to increase awareness and sensitivity to barriers faced by people living in poverty. The outcome also is that participants practice collaboration and networking to aid in getting Veterans the resources that may be available to them. 


United States Census Bureau. (2015).

Income and poverty in the United States: 2014. Retrieved from http://www.census.gov/library/publications/2015/demo/p60-252.html